The electronic Frailty Index (eFI)

The electronic Frailty Index (eFI)  is a validated tool used to identify and grade frailty in individuals aged 65 and over. It operates on a cumulative deficit model, using routinely collected data from GP electronic health records to assess up to 36 health deficits. The number of deficits is divided by 36 to produce a score that categorises individuals as:

  • Fit: 0–4 deficits
  • Mild Frailty: 5–8 deficits
  • Moderate Frailty: 9–12 deficits
  • Severe Frailty: 13+ deficits

This stratification helps clinicians proactively identify patients who may benefit from targeted interventions before they experience significant unplanned service use.

The eFI is based upon a person’s needs, rather than their service use and so it can be used to identify people with lower levels of frailty before they have significant unplanned service use. Therefore these individuals can be targeted with appropriate preventative interventions. All patients within Gloucester have a recorded eFI and two patients can have the same frailty score but a completely different mix of deficits. Rockwood scores utilise a sarcopenia model of frailty rather than a cumulative model. Patients only get a Rockwood upon evaluation by clinician.

The score can be between 1 and 9;

1 = 1 fit,

8 = very severely frail

9 = 9 terminally ill.

Rockwood is only recorded if clinician is concerned about the patient. It can also be done in ED but this is often in a crisis state so is often not reflective of the patients overall status.
Therefore, use of a Rockwood score is good for individual level frailty at a specified time while eFI is more reflective of day to day condition and is better for viewing frailty from a higher population level.

The Gloucestershire Frailty Power Bi report uses eFI as its is better record across our entire population and allows the analysis of high level trends

Integration with Broader Care Models

The eFI is often used alongside tools like the Rockwood Clinical Frailty Scale and Comprehensive Geriatric Assessment (CGA).

NHS England supports the use of eFI as part of the GP contract to identify and support frail patients. It’s considered a key tool in proactive care planning and population health management

 

Resources:

Use of the electronic Frailty Index to identify vulnerable patients: a pilot study in primary care | British Journal of General Practice

NHS England » Electronic Frailty Index

ICBBI0004.02 – Frailty CPG Report – Power BI